When Physicians Fail: Moving Past a Medical Mistake
Health care professionals never set out to make a medical mistake, but errors, missed diagnoses and other missteps that harm patients can happen--often due to system failure. Physicians and other health care providers often become the second victims of an error or adverse event.
“We are human, and we will make mistakes,” said Eunice J. Minford, MBChB, MA, FRCS Ed, a consultant surgeon in Northern Ireland. “It is a fact. Every single doctor makes mistakes without exception. The key is, how do we deal with them and understand them in a way that is healthy?”
Manisha Juthani-Mehta, MD, at the Yale School of Medicine in New Haven, Connecticut, added, “It is important to always recognize that our patients have welcomed us into their lives at a vulnerable moment. We should treat people with honor and respect in these moments. Despite practicing with this principle in mind, we are all human and can make mistakes.”
Physicians and other health care providers aim for perfection and can be devastated when that’s not the outcome.
In a Boston Globe op-ed piece from August 2015, Juthani-Mehta described how she had not forgiven herself for an error made during her internship, even 14 years later. She reported for this article feeling the same.
Positive steps to deal with medical errors
Acknowledge, disclose and communicate
Errors often occur as a result of system problems, said Doug Wojcieszak, founder of Sorry Works!, a nonprofit disclosure training and advocacy organization in Edwardsville, Illinois.
Multiple factors may contribute, Minford added.
Correcting system problems requires disclosure of the medical error or misdiagnosis.
Many organizations have embraced disclosure when an error occurs, said Wojcieszak, who recommends a three-step approach. Begin by empathizing with the patient or family, quickly conduct a review of what happened and report the results of the review to the patient or family, apologize and explain what will change, so it does not happen again.
“Stay engaged with the patient and family,” Wojcieszak advised.
Juthani-Mehta said that if a medical mistake happens, “acknowledging and accepting the error is the first important step. Discussing it directly with a patient can also be very therapeutic for both the physician and patient.”
Acknowledging the error allows for an analysis of what happened and why.
“An acknowledgment that an error has occurred is fundamentally critical as it allows for the process of investigating root causes of the error or mistake,” said Shawn C. Jones, an otolaryngologist in Paducah, Kentucky. “The purpose of these activities ideally should focus on improving processes in order to prevent similar occurrences while simultaneously avoiding assignment of blame as a punitive endeavor.”
Wojcieszak suggested physicians interviewing for a position ask the employer how medical errors are handled.
“Too many hospitals and nursing homes do not have plans,” Wojcieszak said. “Some organizations have it down cold, with a team of people, and it’s been trained.”
Be aware of legal considerations
Physicians and other health care providers are concerned with legal liabilities associated with adverse events or errors.
“It would be unwise not to take the legal ramifications into consideration,” said Jones. “With the exception of New Jersey, all states and the District of Columbia have enacted statutes affording some degree of protection of the disclosure of peer review information.”
Jones added that “awareness of the limitations of your capacity as a human being is crucial to maintaining a sense of well-being. Living in a community of peer support and having a sense of nonjudgmental awareness helps to be able to look honestly and transparently at mistakes while simultaneously being able to look with hope and purpose to the future in spite of those mistakes.”
Reflect, take responsibility and move on
When physicians fail, they often become the second victim. In 2018, Spanish researchers reported that failure has adversely affected 7 out of 10 health workers. Seeking clinician support services from their organization or outside resources can be beneficial.
“Mistakes can be paralyzing; they can disempower us and cause us to lose confidence, and we can be seriously affected by them,” Minford said. “All of that can then detrimentally affect the quality of care we give. But we did not come into medicine to hurt or harm people, nor did we come in to medicine to end up worse off than the patients we are caring for.”
Clinicians must learn to handle mistakes in a way that is not detrimental to their own health, Minford continued.
Wojcieszak suggested the physician take some time away from the care environment after a mistake. Cancel appointments or surgeries for a week.
“When you have been involved in an [adverse] event, you are more likely to have another event shortly thereafter,” Wojcieszak said, adding that, as a second victim, a physician needs time to grieve.
Mistakes always live with you, Juthani-Mehta said, but communicating directly with the patient can help facilitate the healing process for both parties.
“Physicians need to learn to forgive themselves, but this can only happen when you accept that you are fallible first and have the humility to do so,” Juthani-Mehta said.